Understanding the Management of

Faecal Impaction and Constipation

A guide for parents and carers
It is not easy to know when a child has
constipation and can be even more difficult to
know when it started or what caused it.
Constipation in children does not usually get
better on its own. It nearly always needs
treatment with laxatives. If treated early, it
may resolve quickly. However, if it is missed
for some time faecal impaction may develop.
If constipation has gone unnoticed for a few
weeks, then treatment often needs to be
continued for many weeks or months.

Treating constipation
When treating your child’s constipation, the
aim is to give them enough laxative to make
sure that they are passing a medium to large amount of type 4 or type 5 poos most
days (see Poo chart). Laxatives for children should be prescribed by a healthcare
professional.

The laxative usually tried first, when treating constipation in children, is from the group
called Macrogols. These include Cosmocol, Laxido and Movicol. The usual doses of
Macrogol for children with constipation is:

Chart showing maintenance doses of Macrogol laxatives

Child’s age Recommended Daily Dose of Macrogol
1 – 12 months ½ - 1 sachets (paediatric)
1 – 6 years old 1 – 4 sachets (paediatric)
6 – 12 years old 2 – 4 sachets (paediatric)
12 – 18 years old 1 – 2 sachets (adult)

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If the Macrogol on its own is not working, or your child will not take it, then they may be
prescribed a stimulant laxative. The ones used most often are sodium picosulfate or
senna. It is not unusual for a child to need more than one type of medicine to treat
their constipation.

The Macrogols work by adding water to the poo to soften it and make it easier to pass.
The stimulant laxatives make the muscles of the bowel wall work more effectively, so
the poo is moved along the bowel more quickly. This helps to keep it soft.

Faecal Impaction
Some children are so constipated they cannot clear out all the poo that has built up in
their bowel. These children are said to be impacted or to have faecal impaction. It is
not always easy to know when a child has faecal impaction. Often the first sign this
has happened is that the child starts to soil (there is poo in their pants). This is not
their fault; they are not being naughty or lazy. They cannot stop the poo going in their
pants and often do not realise it has happened until someone tells them. It is a sign
that they need laxatives to treat the problem.

Treating impaction
All the poo that has become stuck has to be cleared out of the bowel, otherwise the
soiling will continue, and the constipation will not get better. To achieve this your child
will need to take increasing doses of laxatives. This is often called a disimpaction
regime. Macrogol laxatives are usually used for this.

Your doctor or nurse will tell you how many sachets of macrogol your child needs to
take and for how long. The usual doses for children with faecal impaction are:

Chart showing disimpaction doses of Macrogol laxatives

Child’s age Recommended Dose of Macrogol in sachets

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
1 – 12 months ½-1 ½-1 ½-1 ½-1 ½-1 ½-1 ½-1
1 – 5 years old 2 4 4 6 6 8 8
5 – 12 years old 4 6 8 10 12 12 12
12 – 18 years old 4 6 8 8 8 8 8
(Adult sachets)

It usually takes 2 – 3 days for the macrogols to start to work. By day three you may
start to notice a change in your child’s bowel movements. The number of days your
child will need to stay on the increasing or higher doses will depend on how long it
takes for them to completely empty out their bowel. You will know that their bowel has
emptied because their poo will be watery (Type 7 on the poo chart overleaf). The
watery poo may have little bits in it and may be any shade of brown, but if disimpaction
is complete it will have no big lumps in it. This usually takes between five and seven

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days, although it could take longer. Do not continue with disimpaction for more than
two weeks without the advice of your healthcare professional.

If you are unsure if your child has disimpacted then give your child some sweetcorn to
eat. If appears in your child’s poo within 24 hours the impaction has cleared.

What happens after the impaction has been treated?

When your child has been passing type 7
poos with no lumps the laxative dose will be
reduced. This may be done immediately, or
it may be done gradually. Your healthcare
professional will tell you when to reduce and
what the new dose should be. The aim is to
reduce the dose until your child is passing
type 4 or type 5 stools every day. The dose
at which this happens is called the
maintenance dose. The usual maintenance
dose is about half the disimpaction dose.
This may need to be adjusted according to
your child’s progress.

Your child’s bowel may have become

stretched if they were very constipated for a
long time or impacted. This will take time to
recover, so your child may need to take the
laxatives for a long time. It is usually
recommended to continue with the
maintenance dose of laxatives for at least
three to six months before very slowly trying to reduce them.

How should I try to reduce laxatives?

If you try to reduce the laxatives too quickly your child may struggle to poo – the
constipation may come back. Always follow the advice of your healthcare professional
when reducing the laxatives.

If your child’s poo becomes loose (type 5 – 7) on the Bristol stool chart and they have
been going for a medium to large poo most days, then that would indicate that they
need less laxative. You could start to reduce the dose slightly.

Not all children will develop loose poos as their bowel recovers. If your child has been
having soft, medium to large size poos most days for at least 3-6 months their
healthcare professional may suggest that you try to reduce the laxatives slowly. If your
child is on more than one laxative, it is usually suggested that you only alter the dose
of one at a time.

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It is often suggested that after your child has been on a regular maintenance dose with
no problems for about 6 months you could start to reduce Macrogols by half to one
sachet at a time. E.g. if your child is having two sachets every day you reduce to one
and a half sachets or one sachet a day. Stay at the reduced dose for about four to six
weeks before trying to reduce again.

Stimulant laxatives should also be reduced slowly. These should be reduced by about
2.5mls at a time. E.g. if your child is having 10mls of stimulant laxative (sodium
picosulfate or senna) then reduce to 7.5mls a day and stay at that dose for 4-6 weeks,
before trying to reduce again.

What should I do if my child does not poo or the poos are hard?
If your child is on a maintenance dose of laxatives, they may still have occasional days
when the poos are smaller or harder than usual. They may also have occasional days
when they do not do a poo. The amount and consistency of poo may change if they
have become a bit dehydrated, due to not drinking as much as usual or because they
have been unwell. The poo may also change if their diet changes or if you are trying to
reduce their maintenance dose. This is not usually a problem but may result in
withholding (trying not to poo) in children who have been constipated.

If your child does smaller poos than usual, if the poos are hard (type 1 or 2), if your
child appears to be withholding, or if they have not done a poo at all for 24 hours or
more, then you should give them extra laxatives. If you are reducing the maintenance
dose and you need to give extra laxative more than once a week, then increase the
daily dose to the level at which your child was last doing soft poos most days with no
pain, discomfort or withholding.

There is more information on how to adjust the dose of laxatives on the Poo Nurses
video at www.thepoonurses.uk

Further advice
You should always read the leaflet that comes with any medicine that has
been prescribed for your child.
Always follow the advice given to you by your child’s doctor or nurse. Talk
to them if you have any concerns or questions.

You may also contact the Bladder & Bowel UK confidential helpline at email:
[email protected] or Telephone: 0161 214 4591

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Related information
There is more information about constipation and faecal impaction in the Bladder &
Bowel UK leaflets:
Talk About Constipation
Understanding Childhood Constipation
Understanding Constipation in Infants and Toddlers
Understanding Faecal Impaction
Understanding Macrogol Laxatives

These are and all the other information leaflets about children’s bladder and bowel
issues are available at: https://www.bbuk.org.uk/children-young-people/children-
resources/
For further information about Bladder & Bowel UK services and resources visit our
website at www.bbuk.org.uk

This booklet can be freely downloaded and printed as a whole. However, no part of this document may
be copied or distributed without the authors’ permission.

June Rogers MBE and Davina Richardson

Copyright © Bladder & Bowel UK
Disabled Living 2020
Registered Charity No 224742

Copyright © Bladder & Bowel UK, Disabled Living (2020)